Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant | 266891 | CO |
NPI | 1316423106 |
---|---|
Provider Name | Mr. Jordan Michael Townsend |
First Address | Colorado Springs, CO 80919-3523 |
Second Address | Colorado Springs, CO 80919-3523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2018 |
Last Update Date | 14/07/2018 |